Self-assessment and Reflection of a Surgical Educator

Reynaldo O. Joson, MD, MHA, MHPEd
1996

Content

Introduction||Methodology||Self-assessment and Reflection Document
Evidences Accrued Which Demonstrated the Extent to Which Goals Had Been Met
Judgements About the Extent of Learning Acquired||Plans for Future Actions
Reflection||Discussion||References

The importance of continuing education is universally accepted. Whether continuing education is occurring and adequate at that, only the individual surgical educator can answer the question.

For continuing professional education to be effective, all surgical educators need to be motivated and committed. They must be able to take responsibility for and direct their own learning and improvement (self-directed). Self-assessment and reflection are vital components and the driving forces of self-directed learning¹.

Self-assessment is the involvement of the learners in "establishing standards and/or criteria to apply to their work and their making judgements about the extent to which they have met these criteria and standards."¹ . Such a process invariably lead to learning and a drive to improve.

Reflection occurs when the learners think actively about how and what they have learned, the problems they meet, and their implications. Again, reflection invariably leads to learning and a drive to improve². There is a commonly cited phrase "wisdom through reflection" which signifies the importance of reflection in learning.

Although based on semantics, self-assessment and reflection are different, in practice they merge to become one process that leads to one outcome: learning. Self-assessment induces the learners to reflect on their learning. Reflection involves self-assessment of learning.

After 15 years of being a surgical educator, the author decided to do a formal self-assessment and reflecion for two reasons. The foremost reason is for personal improvement. The second reason is to use the report emanating from such an activity to inform and motivate colleagues in the surgical academe on the improtance of self-assessment and reflection in continuing professional development.

This paper describes the processes and outcomes of self-assessment and reflecion done by the author. Hopefully, the report will not only benefit the author but also colleagues in the field of surgical education.

A retrospective self-assessment and reflection procedure was utilized¹. This is a procedure in which a learner prepares a self-assessment and reflection document for a given project or activity that includes the following items:

1. Goals (both initial and those which emerged during the course)
2. Activities engaged in the pursuit of the goals
3. Evidences accrued which demonstrate the extent to which goals have been met
4. Judgments about the extent of learning acquired
5. Plans for future actions
6. Reflection

In gathering data for the document, the following methods were used:

1. Reflection and recall
2. Record review
3. Filling up of a self-evaluation form using criteria set by peers as well as by self 

Introduction||Methodology||Self-assessment and Reflection Document
Evidences Accrued Which Demonstrated the Extent to Which Goals Had Been Met
Judgements About the Extent of Learning Acquired||Plans for Future Actions
Reflection||Discussion||References

Background Information

In 1981, I completed my General Surgery Residency Program from the Philippine General Hospital.

In 1982, my profession as a surgical educator started when I joined the Department of Surgery of the Philippine General Hospital as a part-time consultant without compensation.

At the end of 1996, I have spent 15 years of my life being a surgical educator as well as administrator of surgical educational programs in various health sciences institutions in the Philippines (Tables 1 and 2).

Table 1. My career as a surgical educator from 1982 to 1996.
Year Started	Institution			Students	Status
1982	PGH Surgery			Residents	Still on (15 yrs)
1982	General Emilio Aguinaldo College of Medicine			Medical Students	(1 year)
1983	Medical Center Manila Surgery			Residents	1995 (13 yrs)
1984	Manila Doctors Hospital Surgery			Residents	Still on (11 yrs)
1985	University of the Philippines College of Medicine			Medical Students	Still on (11 yrs)
1989	Ospital ng Maynila Surgery			Residents	Still on (7 yrs)
1991	Zamboanga City Medical Center			Residents	Still on (6 yrs)
1993	Tondo Medical Center Surgery			Residents	1994 (2 yrs)

Table 2. Administrator of surgical educational programs from 1982 to 1996.
Chair	Committee on Surgical Audits, Department of Surgery, Philippine General Hospital (1985-1989)
Training Officer	Department of Surgery, Manila Doctors Hospital (1987-1988)
Training Officer	Department of Surgery, Ospital ng Maynila, 1996
Professor-in-Charge	Year Level VII, Department of Surgery, U.P. College of Medicine (1988-1989)
Professor-in-Charge	Year Level IV, Department of Surgery, U.P. College of Medicine (1991-1993)
Director	U.P. Postgraduate Institute of Medicine (1989-1991)
Director	UPCM-DOH Postgraduate Circuit Courses (1990-1991)
Director	A General Surgery Course, Manila Doctors Hospital (1990)
Director	A General Surgery Course, Zamboanga City Medical Center (1991-1996)
Director	A General Surgery Course, Tondo Medical Center (1993-1994)
Chief	Division of Head and Neck, Breast, Esophagus, and Soft Tissue Surgery, Department of Surgery, Philippine General Hospital (1994-present)
Program Director	Head and Neck Surgical Oncology, Fellowship, Department of Surgery, Philippine General Hospital (1991-present)
Program Director	Surgical Oncology Fellowship, Department of Surgery, Philippine General Hospital (1995-present)
Member	Campus Advisory Committee, UP Manila School of Distance Education (1995-present)
Coordinator	Teleconferences in Surgery, UP Manila (1994-1995)

 Goals

In 1982, when I started my surgical educator career, my goal was just to teach. My concept of teaching then was just to impart to my students whatever I knew of the discipline of general surgery through presenting and lecturing.

Starting 1985, because of frustrations with poor retention in the presenting and lecturing methods, I shifted emphasis to facilitating learning using primarily an inquiry approach.

Starting 1989, because of my activities in the University of the Philippines Postgraduate Institute of Medicine, I extended the goal of my surgical educator career from an individual institutional concern to a national mission, that of a surgical manpower development in the country.

Activities Engaged in the Pursuit of the Goals

The general activities that I engaged in to facilitate my attainment of goals 1 to 3 consisted of the following:

1. Continuing education in general surgery
2. Practicing general surgery
3. Conducting researches in general surgery
4. Attending and participating in general surgery conferences and postgraduate courses
5. Undergoing surgical oncology fellowship (1984)
6. Formal training in medical and surgical education
7. Master in Health Profession Education (1993)
8. Candidate for Master in Science in General Surgery (1996)
9. Workshops in Distance Education (Writer's Workshop, Teaching On-line)

Goal 1: Imparting Knowledge

Table 3 shows the formal presentation and lecturing that I did from 1982 to 1996 to surgeons and medical students.

Table 3. Activities in imparting knowledge through presentation and lecture.
Year	Total No. of Sessions	Audience/Learners
		Surgeons	Medical Students
1982	6	4	2
1983	3	2	1
1984	2	2	0
1985	6	5	1
1986	4	3	1
1987	2	1	1
1988	8	7	1
1989	16	15	1
1990	9	8	1
1991	19	16	3
1992	16	13	3
1993	13	11	2
1994	17	15	2
1995	15	12	3
1996	9	6	3

Table 4 shows the number of papers published in journals, books, monographs, and self-instructional programs that I wrote from 1982 to 1996.

Table 4. Activities in imparting knowledge through instructional materials.
Activity				Total Number
Books/monographs/self-instructional programs written				22
Published papers ( with 4 international publications)				40

 Goal 2: Facilitating Learning

Table 5 shows the facilitations that I did from 1985 to 1996 to surgical trainees and medical students.

Table 5. Activities in facilitating learning.
Type of Students			When	Frequency
Surgical residents	Philippine General Hospital		1985-present	once a week
	Zamboanga City Medical Center		1991 - 1996	every month
	Tondo Medical Center		1993-1994	every 3 months
	Ospital ng Maynila		1996	once a week
Medical Students UP College of Medicine	Year Level IV		1985-present	a sem/year
	Year Level V		1985-present	every 3 months
	Year Level VII		1985-present	once a week

Goal 3: Developing Surgical Manpower

Table 6 shows the activities that I did along the goal of developing surgical manpower in the country from 1989 to 1996. The programs consisted of continuing medical education in provincial and regional government hospitals, general surgery course, head and neck surgical oncology, and surgical oncology.

Table 6. Activities in developing surgical manpower.

Designed and implemented the UPCM-DOH Postgraduate Circuit Courses in Aklan, Isabela, and Oroquieta, 3x per provincial hospital, 1989-1990.

Designed and implemented the general surgery course in Zamboanga City Medical Center starting 1991 up to 1996.

Designed and implemented the Head and Neck Surgical Oncology Fellowship and Surgical Oncology Fellowship Programs in 1991 and 1995 respectively.

Participated in out-of-town continuing medical education activities (1983-1996).

Introduction||Methodology||Self-assessment and Reflection Document
Evidences Accrued Which Demonstrated the Extent to Which Goals Had Been Met
Judgements About the Extent of Learning Acquired||Plans for Future Actions
Reflection||Discussion||References

Goals 1 and 2: Imparting knowledge and facilitating learning

• The increasing number of invitations and assignments to present and lecture from 1982 to 1996 as seen in Table 3
• The increasing number of invitaions and assignments to facilitate learning from 1985 to 1996 as seen in Table 4
• Regularly invited speaker in the Philippine College of Surgeons' conventions since 1985 (10x)
• Regularly invited speaker in postgraduate courses sponsored by different health science institutions in Metro Manila since 1985 (30x)
• Outstanding Consultant chosen by surgical residents, Department of Surgery, Philippine General Hospital for 3 consecutive years, 1983, 1984, 1985 (Hall of Fame Awardee)
• Letters of consultants and residents of the Department of Surgery and of Year Level V, VI, and VII medical students of the U.P. College of Medicine in 1995 certifying to my outstanding competency as a surgical educator in appealing/protesting the dean's decision to remove me from the faculty roster
• Being an examiner of the Philippine Board of Surgery 

Goal 3: Developing Surgical Manpower

• The General Surgery Course in Zamboanga City Medical Center produced 9 graduates in 1995, 4 serving the surgical needs of people of Zamboanga City and 5, the needs of people of Sulu, Zamboanga del Sur, and Zamboanga del Norte.
• The Head and Neck Surgical Oncology program produced 5 graduates, two practicing in Mindanao, one in southern Luzon, and three in Metro Manila.
• The Surgical Oncology Program produced 2 graduates, one joining the faculty of the program and the other practicing in the Visayas.

Table 7 shows the results of my personal self-assessment as a surgical educator using a guide which I received from my mentor when I was still a student in the Master of Health Profession Education Program in the U.P. National Teacher Training Center for Health Profession in 1992. This guide was adapted from a paper entitled "Self-directed Learning to Educate Medical Educators"³. I added some criteria on my own.

Table 7. Self-assessment of a teacher (R.O. Joson)
Directions: Assess your training needs on each of the competences listed below. Use the rating scale where: 1- means I'm already competent and do not need to learn about it 2- means I'm fairly competent and need a little improvement 3-means I need a lot of improvement Place NA if a non-applicable situation arises.
IN PLANNING AND IMPLEMENTING TEACHING, I DO/WOULD
1. Provide the greatest opportunities for students to participate in the session.										1
2. Include practical activities for learning.										1
3. Use methods which encourage students to learn problem-solving skills.										1
4. Select methods appropriate to the objectives.										1
5. Vary the methods I use.										1
6. Let student share control of the learning situation.										1
7. Use each of these methods appropriately and with confidence: 7.1 Small group discussion 2 7.2 Lectures 2 7.3 Clinical teaching 1 7.4 Demonstration 1 7.5 Project work 1 7.6 Independent study 1
8. Apply with confidence the following skills: 8.1 Introducing a topic 1 8.2 Explaining 2 8.3 Questioning 2 8.4 Giving feedback 2 8.5 Encourage students' participation 1 8.6 Class management 2 8.7 Closure 2
9. Other issues about teaching skill that I can think of: 9.1 Oral communication skills 2 9.2 Written communication skills 2 9.3 Making students more at ease and relaxed 3 9.4 Helping students develop a self-directed learning habit 2

As to the goal of developing surgical manpower, I am satisfied with the present achievement. I just have to continue the project and to do more.

Plans for Future Actions

The general plan is to continue to be committed to a self-directed learning habit so as to improve further and to become a surgical educator better than what I am now.

The specific plans are:

1. To acquire skills to make the students more relaxed during a teaching-learning session.
2. To improve on my written and oral communication skills concentrating on the English language which is actually my third language.
3. To finish my thesis in Master of Science in General Surgery so as to strengthen my capability to help improve general surgery training program in the country.
4. To pursue a doctorate in organizational development and planning so as to help me effect and sustain reforms in surgical education in the country.

Introduction||Methodology||Self-assessment and Reflection Document
Evidences Accrued Which Demonstrated the Extent to Which Goals Had Been Met
Judgements About the Extent of Learning Acquired||Plans for Future Actions
Reflection||Discussion||References

Am I doing continuing professional education? Yes, I am.

Is it adequate? Yes it is, at least for now.

Am I a self-directed learning? Yes, I am

Over the years, I have changed my concept of teaching-learning. It is more than imparting and transferring of knowledge. It is facilitating learning. My educational approach has shifted from teacher-centered to more of student-centered, passive to active student participation, and use of problems in learning. My ultimate criterion of success as an educator is whether my studentss have developed a self-directed learning habits or not.

My 15-year experience as a surgical educator has taught me a lot of things. There are more to explore and to learn. At present, I amy trying to develop an objective, structured screening procedures for surgical trainees; problem-based learning in surgery; distance learning in surgery; and a structured training program for general surgeons.

Education is not completed with the attainment of a diploma or degree. It is a continuing process from the cradle to the grave.

All surgical educators must continually educate themselves in order to improve their competence. To be able to do this, they must have developed a self-directed learning habit or skill and must be committed to this until they or become incapacitated.

A self-directed learning habit is acquired if someone realizes his personal learning needs and then sets out to fulfill these needs. The first step in developing a self-directed learning habit is to learn how to do self-assessment. Without the self-assessment skill no self-directed learning can take place. After determining the learning needs from the self-assessment, the learner then formulates a learning plan, implements it, and assesses the outcome. Self-assessment and reflection are done at the end of the implementation to determine whether the learning objectives have been achieved, how the learning plan was implemented, and what other improvements or learnings there are that must still be accomplished. There is no such thing as the end of learning for there are always rooms for improvement. Thus, for improvement sake, the whole cycle of self-directed learning activities is repeated again and again.

Analyzing my own self-assessment and reflection document, I say that I have been doing self-directed learning for my career during the past 15 years. My changing and additional goals as years passed by, I believe, are enough to support my statement. What more of the formal education that I took and am taking up to this point in time (master in health profession education, master of science in general surgery, and doctorate in organizational development and planning).

As mentioned, this self-assessment and reflection activity was primarily done for personal consumption. However, I am publishing this document to serve as a model of doing self-assessment and reflection. I hope educators reading this paper will start doing such kind of self-assessment and reflection as part of their commitment to self-directed learning and continuing professional education.

1. Bould D: How to facilitate self-assessment. In The Medical Teacher. In Cox K and Ewan CE (eds). New York, Churchill, Livingstone, 2nd ed, 1988, p. 193-196.
2. Bould DJ, Kilty JM: Self-appraisal: an approach to academic staff development. In Cryer P (ed) Training activities for teachers in higher education, Vol Two, Society for Research into Higher Education, Guildord, Surrey, p. 33-44.
3. Hammond M, Collins R: Self-directed learning to educate medical educators. Part I: how do we use self-directed learning? Medical Teacher 9:253-260, 1987.

Introduction||Methodology||Self-assessment and Reflection Document
Evidences Accrued Which Demonstrated the Extent to Which Goals Had Been Met
Judgements About the Extent of Learning Acquired||Plans for Future Actions
Reflection||Discussion||References
Abstract

Health Profession Education
Education for Health Development in the Philippines